Care Home: Elm Grove Nursing Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

Annual service review Name of Service: Elm Grove Nursing Home The quality rating for this care home is: The rating was made on: two star good service 1 0 1 2 2 0 0 8 A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Janice Patrick1 Date of this annual service review: 3 0 0 3 2 0 1 0 Annual Service Review Page 1 of 8 Information about the service Address of service: 42 Somerford Road Cirencester Gloucestershire GL7 1TX 01285653057 01285885798 Telephone number: Fax number: Email address: Provider web address:   www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Name of registered provider(s): Name of registered manager (if applicable) Mrs Ann Cynthia Helen Carter Conditions of registration: Category(ies) : dementia old age, not falling within any other category Conditions of registration: Number of places (if applicable): Under 65 Over 65 22 0 0 38 That a designated person with two years proven experience in dementia care and staff supervision leads the day-to-day care within the Dementia Care Unit. The maximum number of service users who can be accommodated is 60. Have there been any changes in the ownership, management or the No service’s registration details in the last 12 months? If yes, what have they been: Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service Elmgrove is part of the BUPA Care Homes Group and provides general nursing and personal care to people over the age of 65 years. It also has a designated unit where those suffering from dementia can receive personal care. Annual Service Review Page 2 of 8 1 0 1 2 2 0 0 8 The home is within a residential area of Cirencester Town and is near to several bus routes. There is a communal lounge and dining room in the main home with a designated space for activities. The dementia care unit has two communal areas consisting of lounge and dining area. All bedrooms throughout the home have en suite facilities and are for single occupancy. The home as a whole has many adaptations designed to make daily living easier for the people living in the home. The dementia care unit has additional modifications which help the people who are confused. The main home has a large garden and ample parking, as does the dementia care unit, although additional arrangements are in place here to meet the specific needs of this client group. The home has qualified nurses on duty 24 hours of the day and care staff receive specific training in the needs of those with dementia. Current care fees range from eight hundred and fifty pounds to nine hundred and fifty pounds per week. Fees vary depending on the level of care provided and the size of bedroom. Annual Service Review Page 3 of 8 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at the information that we have received, or requested, since the last key inspection. This included: 1.The annual quality assurance assessment (AQAA) that was sent to us in October 2009. This is a self-assessment that focuses on how well the outcomes are being met for the people using the service. It also gave us some numerical information. 2.We have drawn on the findings of the most recent key inspection report of 8th January 2007, which stated that Elmgrove provides a good standard of care. 3.We also took into account what the organisation has told us about things that have happened to the service, these are called notifications and are a legal requirement. It appears that these incidents were managed appropriately. 4.There has been one complaint brought to our attention which the service investigated and responded to. There have been no issues regarding adult protection which have been brought to our attention since the last key inspection. This Annual Service Review has been completed with the use of questionnaires, seeking the views of people who live in the home, relatives, staff and visiting professionals. What has this told us about the service? The key inspection of 8th January 2007 provided us with the following information about Elmgrove: Prospective new residents were given plenty of information before they moved to the home and could be re-assured that there would be a full assessment of their needs. Residents were treated with respect and dignity and were supported by staff to live as fulfilling and independent lives as possible. It was a well managed home which had a welcoming atmosphere. The environment was safe, well maintained and clean. Many residents and families spoke positively about the home and the staff who provided the care. Residents were having their health and personal needs supported. Residents could expect their complaints to be listened to and acted upon. There had not been a high volume of complaints and any concerns were being addressed. There were policies and procedures in place to help safeguard people from abuse but better staff awareness of these procedures would improve their protection. A recruitment process was in place and was always completed, but for two staff members the home could not demonstrate completion of this process before the staff started work. Staff were benefiting from an ongoing rolling programme of training but the percentage of staff attaining the National Vocational Qualification (NVQ) in care needed to increase. Some staff were not receiving regular supervision. Four requirements were made at the last inspection. These included the following: Annual Service Review Page 4 of 8 A statement needed to be provided to people who received free nursing care contributions. Arrangements needed to be made to improve staffs awareness of abuse and what they needed to do in the event of an allegation or incident. The home needed to ensure that all new staff received clearances from the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) list (now the Independent Safeguarding Authority (ISA) First Adult check. Staff supervision needed to be provided regularly and as required, with particular reference to night staff. The manager has sent the AQAA to us. This has provided us with the following information: Everyone has their needs assessed before they move into the home, appropriate and helpful information is made available. Residency contracts are issued to everyone and have been reviewed. The home continues to review all care plans which are kept up to date. There is an established quality audit system in place to ensure this is being achieved. Care plans continue to focus on peoples equality and diversity as well as their health and personal care needs. New documentation allows peoples wellbeing to be monitored. Over the next twelve months the home plans to increase its capacity to care for people with dementia. Menus have been reviewed and expanded to provide for greater choice. People in the dementia care unit have made good use of the companys nite-bite system, where a small menu of food is available at night. There remains a structured activities programme in place and weekend activities are encouraged. SONAS based activities are being delivered in the dementia care unit with success. The home feels it could do better by making sure that everyone who wants to join in activities is given the opportunity to do so. The plan for the next twelve months is to maintain a stimulating activities programme. There has been an overall improvement to the staffs awareness, the clients awareness and advocates in relation to safeguarding of adults. The home has had two complaints in the last twelve months; both addressed within the homes stated time frame. The home continues to be kept clean and well maintained. The AQAA does not make comment about any refurbishment or redecoration to the home in the last twelve months but does say that the environment is maintained. The home complies with all water supply regulations. The kitchen has been awarded five stars by the Environmental Health Officer (EHO). This means that there are high standards of cleanliness and good maintenance of necessary records. The home has received one formal complaint in 2009. The complaints policy has been updated and now includes the recording of verbal complaints. There has been an improvement in staff retention and this has resulted in a better skill mix in the home, which the home plans to maintain. Staff training is up to date and good recruitment practices are being carried out, to include all appropriate checks on new staff. The AQAA does not tell us about any additional training plans for the next twelve months. The home have day to day arrangements in place for immediate and small maintenance issues and health and safety checks. The company have specialist that can be called on for advice and regular audits are carried out and monitored by the Annual Service Review Page 5 of 8 companys quality and improvement team. We received four questionnaires back from people who live in the home (this is a low response). They all confirmed that they had enough information about the home to help them make a decision and they have all received contracts. Two said they always get the support they need, one said they usually get this and one said sometimes. Three said staff are usually available when needed and one person answered sometimes. All agreed that the staff listen to them and do what they ask. Three said they always get medical support and one answered sometimes. There was a mixed response to being able to take part in activities with one person saying they can always do this, one saying usually and two saying sometimes. Specific comments were made about activities and providing stimulation to those living in the home. One relative said my ........ is often left in her/his room with no stimulation, another said supply more light classical music and tunes from the thirties/forties etc during meal times or rest time in the lounge and allow carers more time to chat to the residents. People had mixed views on the food. One specific comment was that there are very small portions served and its often not very palatable. Another comment was made about drinks not always being left within reach. One relative commented that squash and fruit should be provided instead of families having to purchase this. Another person felt the home was flexible with mealtimes and someone else thought the home provided good home cooking. All but one person said they knew who they could talk to if they were concerned about something and responses were the same for knowing how to make a complaint. Two questionnaires confirmed that the home was always clean and fresh and two said usually. One specific comment said usually very clean and free from odours often associated with nursing homes i.e urine etc. One person felt the home gave a good laundry service another person said take more care of clothes, stuffed into drawers and not hung up. One person said supply sufficient wheelchairs with full working parts, brakes, foot rests and cushions. A person who lives in the home said they look after you well and its warm, clean and comfortable. A relative said myself, family and friends are very happy and impressed, all staff are friendly and courteous, homely atmosphere. We received six staff questionnaires back. All confirmed that relevant checks were carried out when they were employed, which included a Criminal Record Bureau (CRB) clearance and references. Two agreed that their induction covered all aspects required very well, three felt this had been mostly achieved and one answered partly. They all agreed that they are given appropriate Annual Service Review Page 6 of 8 training except for one person who did not feel their training had helped them to understand peoples needs. Two put not applicable to medicine training and helping them to understand peoples needs. Four agreed the manager regularly gives them support, one answered sometimes and one answered never. One staff member felt that communication in the team was always good, four felt it was usually good and one answered not applicable. All agreed there were usually enough staff on duty. One relative said, under what the home could do better, more staff, usually very few staff on duty to care for all the residents. We received one questionnaire back from a visiting doctor. This person confirmed that the home usually makes accurate assessments on people and that they usually review and monitor peoples health care needs and seek advice on how to improve someones well being. They confirmed that peoples privacy and dignity is always maintained and peoples diverse needs are usually responded to. They also confirmed that people who are in the home on a short term basis are supported to administer and manage their own medicines. They said that any concerns raised by them are always responded to appropriately. This person specifically said they have expanded their service to care for more severely demented people and I think this is a positive move with more trained staff. They also said communication can I think be improved and I regard Elmgrove as a solid safe nursing home for my patients. Another questionnaire was completed by a representative of the Alzheimers Society who had been asked to attend a relatives support meeting. This person said that the staff seemed well trained and were keen to support not only the people living in the home but the relatives as well. They considered these meetings to be of great value to relatives who have someone in the home with dementia. They confirmed that the home seek advice from the society. What are we going to do as a result of this annual service review? There is no evidence to indicate that standards have fallen at Elmgrove. We have noted some of the more specific comments relating to activities, food, staffing and provision of wheelchairs and will monitor these areas. The AQAA implies that two of the four requirements have been addressed but is difficult to establish whether all staff are receiving adequate supervision. We are aware that BUPA now have arrangements in place to provide financial statements/invoices to people regarding their individual free nursing care. We will continue to monitor all information given to us and future site visits and reviews will be subject to any changes in registration and inspection practice following implementation of the Health and Social Care Act 2008. Annual Service Review Page 7 of 8 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. The content of which can be found on our website. Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a copy of the findings in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Annual Service Review Page 8 of 8 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!